WEA Select Qualified High Deductible Health Plan (QHDHP)

Transcription

1 WEA Select Qualified High Deductible Health Plan (QHDHP) Summary of Benefits October 1, 2012 September 30, 2013 WEA Select Customer Service Team

2 How does the WEA Select QHDHP compare to the other WEA Select Plans? The QHDHP is a qualified high deductible health plan that is designed to work with a Health Savings Account (HSA). The WEA Select QHDHP uses the Foundation network. There is no first dollar coverage. You pay 100% of the cost until you reach your (or your family s) deductible,* except for in-network preventive care benefits, which are covered in full. Please refer to the summary of benefits chart for deductible amounts. Once you meet your deductible, you and the plan will share in the cost of covered medical expenses. Your share is called coinsurance. If you cover one or more dependents, benefits will not begin for any family members until the family deductible is met. The in-network deductible under the WEA Select QHDHP is higher than the deductible under any of the other WEA Select Plans. Unlike the other WEA Select Plans, amounts that go toward satisfying the deductible in the fourth quarter are not credited toward the next year s deductible. The WEA Select QHDHP has a separate deductible for out-of-network services, which is double the in-network deductible. All services are covered in full when you meet your out-of-pocket maximum. The out-of-pocket maximum includes deductibles and coinsurance not premiums. The family out-of-pocket maximum must be met before services are covered in full for any single family member. If you (and your covered dependents) are enrolled in the QHDHP and you are making or receiving HSA contributions, you and your covered dependents cannot be covered on any non- HDHP plans. If enrolled on an HSA, the WEA Select QHDHP will only coordinate benefits with non-wea tax-qualified high-deductible health plans. There is no dual WEA coverage when enrolled on the WEA Select QHDHP. The WEA Select QHDHP may be used with a tax-qualified HSA. * Federal guidelines set the minimum annual deductible and out-of-pocket limits. What is an HSA? An HSA is an account you fund to pay for current health expenses not covered by your medical plan, such as deductible and coinsurance amounts. Funds can be withdrawn tax-free when used to pay for qualified healthcare expenses. You can find a list of qualified HSA expenses at and search for IRS Publication 502. If funds in your HSA are used for anything other than qualified medical expenses, they will become taxable income and are subject to a 20% penalty tax.

3 Unused funds remain in your account. They can carry forward and grow from year to year. The HSA belongs to you. You keep the account even if you decide to change jobs or retire. You can only contribute to an HSA when you are enrolled in an HSA-qualified high-deductible health plan. Please note that your calendar year HSA contribution limits are set by the IRS.** ** For more detailed information, refer to IRS Publicaton 969, Health Savings Accounts and Other Tax-Favored Health Plans, that you can download from This material is not intended to be tax or legal advice. The reader should consult with his or her own tax advisor to determine the tax implications of participating in a Health Savings Account. How to enroll in the WEA Select QHDHP and an HSA 1. First enroll in the WEA Select QHDHP Complete the WEA Select Medical/ Vision Enrollment Application. Complete and sign the HSA Checklist. Keep copies of the application and checklist for yourself. Submit the application with the completed checklist to your employer. 2. Then set up your HSA Make sure you are qualified to open an HSA. Contact your district administrator to enroll in an HSA. Open and fund your HSA account through an HSA trustee (such as a bank). You must meet the IRS requirements listed in IRS Publication 969 to enroll in an HSA. Please refer to for more information. Helpful Definitions Allowed Amount The maximum amount Premera will pay for a covered service or supply. Coinsurance The percentage of a covered service you pay after your deductible has been met. Cost Share This represents what you pay. Deductible The amount you pay each year before your plan starts to pay benefits toward certain services. Network Your plan s contracted provider network (Foundation) determines which doctors, hospitals and other health care providers are covered at your plan s in-network benefit level. Out-of-pocket Maximum The maximum amount you pay out of your own pocket for coinsurance and deductible in a calendar year.

4 WEA Select Qualified High Deductible Health Plan (QHDHP) Provider Network = Foundation COST SHARES IN-NETWORK OUT-OF-NETWORK DEDUCTIBLE (PCY) Individual $1,500 $3,000 Family $3,000 $6,000 COINSURANCE OUT-OF-POCKET MAXIMUM (PCY) Individual $4,000 FOURTH QUARTER DEDUCTIBLE CARRYOVER ANNUAL PLAN MAXIMUM Family $8,000 Not Available $2 million Unlimited Out-of-Pocket maximum includes in-network deductible/coinsurance and prescription drug coinsurance. There is no out-of-pocket maximum for out-of-network services. Cost share amounts represent what you pay. All services subject to deductible except as noted.* COVERED SERVICES IN-NETWORK OUT-OF-NETWORK PREVENTIVE CARE Exams/Immunizations Not covered $0* Preventive Screenings 50% PROFESSIONAL CARE Office Visit Outpatient Professional Services Inpatient Professional Services ALTERNATIVE CARE Manipulations (Spinal & Other) 12 visits PCY Acupuncture 12 visits PCY Naturopathic Services DIAGNOSTIC SERVICES Mammography (Non-preventive) Outpatient Diagnostic Imaging & Laboratory Services EMERGENCY CARE Emergency Care Ambulance (Air or ground) FACILITY CARE Inpatient Care Outpatient Facility Care MATERNITY 20% 20% Maternity (Prenatal, delivery & postnatal care) OTHER SERVICES Mental Health Care (Inpatient/outpatient) Rehabilitation (Physical, Occupational, Speech and Massage Therapy) Outpatient: 15 visits PCY; Inpatient: 30 days PCY PRESCRIPTION DRUGS (Subject to medical deductible) Retail Pharmacy Up to 30 day supply Mail Order Pharmacy Up to 90 day supply Specialty Drugs Up to 30 day supply NOTE: A few generic prescription drugs are not subject to deductible and are covered in full. 20% 20% UNUM Life and AD&D Insurance $12,500 Term Life and AD&D for employee only * Not subject to the calendar year deductible Unum is an independent provider of life insurance services that does not provide Premera Blue Cross products or services. Unum is solely responsible for its products and services. PCY = Per Calendar Year NOTE: This summary is intended to assist you in decision making. Details of covered benefits, limitations, and exclusions are provided in the WEA Select Health Plan benefit booklets. This summary of benefits is not a contract.

5 Do you qualify for an HSA? You must meet the following IRS requirements You must be enrolled in an HSA-qualified high-deductible health plan, such as the WEA QHDHP. You (and your spouse, if you have family coverage) have no other health coverage, except for another QHDHP. However, you can still be an eligible individual even if your spouse has a non-qhdhp, provided you are not covered by that plan. You are not enrolled in Medicare. You cannot be claimed as a dependent on someone else s tax return. Please note: If you do not meet the IRS requirements for an HSA, the WEA Select QHDHP may not be the right plan for you. If you enroll in the WEA Select QHDHP and determine at a later date that you do not qualify to participate in an HSA, you must wait until your next annual open enrollment to change plans (unless you experience a qualified event). You cannot contribute funds to a general purpose Flexible Spending Account and an HSA at the same time. Your eligibility may be affected if you have access to the following: employer s on-site clinic, VA benefits, Tri-Care or an Indian clinic. Does a QHDHP with an HSA fit your budget? If you meet all of the IRS requirements to open an HSA, see if an HSA is within your means. You should carefully consider the following before enrolling in this plan. Are you financially able to pay 100% of your health care costs until you meet your individual (or family, if covering one or more dependents) deductible amount? The employee-only in-network deductible is $1,500. The employee and dependent(s) deductible is $3,000. Only in-network preventive services and a few generic preventive drugs are covered in full. How much do you need to set aside for medical expenses this year? Review your claims information from the previous year by logging in to and clicking on Spending Activity Report. Include any elective services planned for the coming year (i.e., surgeries or maternity care). Make sure you have access to your family s claims information.

6 Contact Information WEA Select Customer Service Team Hearing Impaired TDD :00 a.m. 6:00 p.m., Monday through Friday WEA Plan Consultant: Life insurance underwritten by: (206) ( )